Florida State College At Jacksonville
2015 Employee Benefits Guide
College President
Dr. Cynthia Bioteau
Eligible employee benefits are effective the first day of the month following date of hire.
The information provided herein is a summary of benefits for full-time employees and should not be
construed as part of any provider contract. Possession of this guide does not imply coverage nor
does it guarantee benefits.
TABLE OF CONTENTS
I.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
II.
Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
III.
Section 125 and Benefit Election Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
IV.
Health Plans
A. Health Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. Medical Premiums by Employee Salary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Discounted Programs and Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
D. Uninsured Children Coverage Option . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3-6
7
8
9
Dental Plans
A. Delta Care (DHMO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. Delta (PPO) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
10
11
Vision Care Plan
A. Humana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
12
V.
VI.
VII.
Florida College System Risk Management Consortium
Dental and Vision Plan (DV) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
VIII.
Tax Advantaged Plans
A. MEDCOM - Flexible Spending Account (FSA) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. Voluntary 403(b) Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Voluntary 457(b) Deferred Compensation Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . .
D. Mandatory 403(b) Terminal Leave Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14
15-16
15-16
17
Retirement Plans
A. Florida Retirement System Pension Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
B. Florida Retirement System Investment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
C. Community College Optional Retirement Program . . . . . . . . . . . . . . . . . . . . . . . . .
18
18
18
X.
Life Insurance Coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
19
XI.
Long Term Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .
20
XII.
Employee Assistance Program (EAP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
20
XIII.
Additional Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
21-23
XIV.
Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
24-25
IX.
*The summary plan documents are located at www.fccj.org/campuses/mccs/humanresources/
Introduction
FSCJ is committed to our employees and is pleased to offer challenging and fulfilling careers, as well as an excellent
benefits package. This guide will help you make the best informed decisions regarding your coverage by providing
information about:
 Eligibility requirements
 Benefits plans
 Important contact information
Eligibility
Full-time employees are eligible to participate in the benefits plans described in this guide. Benefits are effective on the first
day of the month following the employee’s date of hire for both the employee and their dependents (employees must enroll in
their benefits within 30 days of their hire date). Dependent verification documentation will be required prior to coverage
effective date. Employee and dependent premiums are paid one month in advance. Listed below are additional eligibility
rules:



Up to age 26 in the medical, dental and vision plans, (terminates on the last day of the calendar year in which child
reaches age 26)
Age 26 up to age 30 employee pays the full cost of coverage (terminates on the last day of the calendar year in
which the dependent child reaches age 30)
Disabled dependent children beyond the age of 30 (reference Eligibility for Coverage section 10-2 Blue Options
Booklet)
Section 125 and Benefit Election Changes
Under Section 125 of the Internal Revenue Service (IRS) code, you are allowed to pay for certain group insurance premiums
with pretax dollars. This means your premium deductions are taken before Federal Income and Social Security taxes are
calculated. Depending on your tax bracket, your savings could be significant.
You should carefully decide on your benefit elections, including the choice to decline coverage. Your pretax elections will
remain in effect until the next annual open enrollment period, unless you experience an IRS-approved qualifying life event.
Qualifying life events include, but are not limited to:
* Marriage, divorce or legal separation
*A spouse or domestic partner’s employment begins or ends
*Death of Spouse, domestic partner or legal dependent child(ren)
*Birth or adoption of a child
Employees may make changes to their health, dental and vision plans (i.e., add/drop dependents) as well as modify their
Flexible Spending Account deductions within 30 days of a qualifying event.
For changes made due to ANY qualifying event, supporting documentation is required. Please contact a Benefits Specialist
for assistance at benefits@fscj.edu.
2
2015 Medical Benefits Plan Options
Cost Sharing - Member's Responsibility
BlueCare 51
(HMO Plan)
BlueOptions 03769
(Base PPO Plan)
BlueOptions 03559
(PPO Plus Plan)
Health Care Reform
Compliant
Health Care Reform
Compliant
Health Care Reform
Compliant
Deductible (DED)
Per Calendar Year
(Per Person/Family Aggregate)
In-Network
NA
$600 / $1,800
$600 / $1,800
Out-of-Network
Coinsurance (BCBSF pays/Member pays)
In-Network
Out-of-Network
Out of Pocket Maximum (OOP)
(Per Person/Family Aggregate)
NA
Combined w/ INN
Combined w/ INN
NA
NA
80% / 20%
60% / 40%
80% / 20%
70% / 30%
Includes Pharmacy
Includes Pharmacy
Includes Pharmacy
$5,000 /$10,000
N/A
$6,000 / $12,000
Combined w/ INN
$6,000 / $12,000
Combined w/ INN
$200
Combined with Preferred
OOP
NA
$200
Combined with
Preferred OOP
NA
$30
$50
Not Covered
$30
$50
Ded + 40%
$10
$10
Not Covered
$10
$10
Ded + 40%
DED + 30%
$30
Not Covered
$30
Ded + 40%
DED + 30%
$0
Not Covered
$100
$100
In-Network (includes deductible; co-insurance;
copays and pharmacy)
Out-of-Network
Medical Pharmacy OOP Maximum
(Per Person Per Calendar Month)
In-Network (Preferred)
In-Network (Non-Preferred)
Out-of-Network
$200
Combined with
Preferred OOP
NA
Medical / Surgical Care by a Physician
Office Services
In-Network Family Physician
In-Network Specialist
Out-of-Network
Allergy Injections (Office)
In-Network Family Physician
In-Network Specialist
Out-of-Network
Convenient Care Center (Minute Clinics)
In-Network
Out-of-Network
Physician Services at Hospital
In-Network
Out-of-Network
Preventive Services (Adult & Well Child)
All Locations of Services
In-Network Family Physician
In-Network Specialist
Out-of-Network
Mammograms
In-Network
Out-of-Network
Colonoscopies
(preventive and diagnostic)
In-Network
Out-of-Network
$30
$50
DED + 30%
$10
$10
$30
DED + 20%
INN DED + 20%
Subject to the US Preventive Care Guidelines
$0
$0
Not Covered
$0
$0
40%
$0
$0
30%
$0
Not Covered
$0
$0
$0
$0
1 every 10 years for preventive/1 every 2 years if high risk
$0
$0
Not Covered
$0
3
$0
$0
Medical Benefits Plan Options, cont’d
Cost Sharing - Member's Responsibility
BlueCare 51
(HMO Plan)
BlueOptions 03769
(Base PPO Plan)
BlueOptions 03559
(PPO Plus Plan)
Health Care Reform
Compliant
Health Care Reform
Compliant
Health Care Reform
Compliant
Medical / Surgical Care at a Facility
Ambulatory Surgical Center (ASC)
In-Network
Out-of-Network
Inpatient Hospital Facility (per admit)
In-Network
Out-of-Network
$200
Not Covered
$250 per day up to $1,250
Max
Ded + 20%
Ded + 40%
Ded + 30%
Option 1: Ded + 20%
Option 2: Ded + 20%
Option 1: $750
Option 2: $1,500
Not Covered
Ded + 40%
$200
Not Covered
Option 1: Ded + 20%
Option 2: Ded + 20%
Ded + 40%
$75
$2,500
Outpatient Hospital Facility (per visit) (Surgical)
In-Network
Out-of-Network
Outpatient Hospital Facility (per visit)
(Non-Surgical)
In-Network
Out-of-Network
Non-Routine Colonoscopy (Medically Nec.)
In-Network
Out-of-Network
$0
Not Covered
Included with Surgical
Services
$0
Not Covered
Option 1: $150
Option 2: $250
Ded + 30%
Included with Surgical
Services
$0
Ded + 40%
DED + 30%
$0
DED + 20%
INN DED + 20%
$100 + 20%
$100 + 20%
Emergency and Urgent Care
Emergency Room Facility (per visit)
(No surgery performed or not admitted)
In-Network
Out-of-Network
$100
$100
In-Network
Out-of-Network
$0
$0
$100
$100
DED + 20%
INN DED + 20%
$0
$0
$100
$100
DED + 20%
INN DED + 20%
Physician Services at ER
(Surgery performed or with admit)
Physician Services at ER
(No surgery performed or not admitted)
In-Network
Out-of-Network
Urgent Care Centers
In-Network
Out-of-Network
$80
Not Covered
$65
Ded + 40%
DED + 30%
$50
DED + 20%
INN DED + 20%
DED + 20%
INN DED + 20%
Ambulance
In-Network
Out-of-Network
Diagnostic Testing (e.g., Lab, x-ray)
Physician Office
In-Network Family Physician
In-Network Specialist
Out-of-Network
Independent Clinical Laboratory
In-Network
Out-of-Network
20%
20%
$30
$50
Not Covered
$0
Not Covered
$30
$50
Ded + 40%
QUEST is the In-Network Lab
$0
Ded + 40%
$30
$50
DED + 30%
$0
DED + 30%
Independent Diagnostic Testing Center
In-Network
Out-of-Network
$50
Not Covered
$50
Ded + 40%
In-Network
Out-of-Network
$0
Not Covered
Option 1: Ded + 20%
Option 2: Ded + 20%
Ded + 40%
DED + 20%
DED + 30%
Outpatient Hospital Facility
4
Option 1: $150
Option 2: $250
$350
Medical Benefits Plan Options, cont’d
Cost Sharing - Member's Responsibility
BlueCare 51
(HMO Plan)
BlueOptions 03769
(Base PPO Plan)
BlueOptions 03559
(PPO Plus Plan)
Health Care Reform
Compliant
Health Care Reform
Compliant
Health Care Reform
Compliant
Outpatient Therapy
Physician Office
In-Network Family Physician
In-Network Specialist
Out-of-Network
$5
$5
Not Covered
$30
$50
Ded + 40%
$30
$50
DED + 30%
In-Network
Out-of-Network
$30
Not Covered
$50
Ded + 40%
DED + 30%
In-Network
Out-of-Network
$30
Not Covered
Option 1: $30
Option 2: $50
Ded + 40%
Option 1: $45
Option 2: $60
DED + 30%
Outpatient Rehabilitation Facility
$50
Outpatient Hospital Facility
Mental Health and Substance Dependency
Services
All location of Service
In-Network Family Physician
In-Network Specialist
Out-of-Network
$0
$0
Not Covered
$0
$0
40%
$0
$0
30%
1 Per lifetime
1 Per lifetime
1 Per lifetime
In-Network
Combined (INN & OON)
1 / 2 years
N/A
N/A
1 / 2 years
1 / 2 years
In-Network
Combined (INN & OON)
1 / 10 years
N/A
N/A
1 / 10 years
1 / 10 years
N/A
N/A
35 Visits PBP
35 Visits PBP
90 Days Per year
N/A
N/A
60 Days Per year
N/A
N/A
N/A
26 Per year
N/A
N/A
Benefit Maximums
Gastric Bypass
High Risk Colonoscopy
N/A
Preventive Colonoscopy
Outpatient Therapy & Spinal Manipulations
Combined (In-Network/Out of Network)
Combined (INN & OON)
Skilled Nursing Facility
In-Network
Combined (INN & OON)
Spinal Manipulations
In-Network
Combined (INN & OON)
N/A
N/A
60 Days Per year
N/A
26 Per year
Prescription Drugs
Deductible
In-Network
- Retail
N/A
Generic/Brand/Non-Preferred
$10 / $60 / $100
$15 / $45 / $65
$15 / $60 / $100
Generic/Brand/Non-Preferred
$30 / $120 / $200
$30 / $90 / $130
$30 / $120 / $200
Generic/Brand/Non-Preferred
50%
50%
50%
Generic/Brand/Non-Preferred
50%
50%
50%
- Mail Order
Out-of-Network
- Retail
- Mail Order
Definitions: INN = In-network; OOP = Out-of-Pocket; OON = Out-of-Network; PBP = Per Benefit Period
This is a summary of benefit only. The written terms of the contract prevail.
5
Hospital Options
Option 1 Hospitals Include:







Baptist Medical Centers;
Memorial Hospital of Jacksonville;
St. Vincent’s Medical Centers;
Wolfson Children’s Hospital;
Orange Park Medical Center;
Mayo Clinic* and
Flagler Hospital.
Option 2 Hospitals Include:

Shands Jacksonville Medical Center and Hospitals are outside the
Jacksonville surrounding areas.
*Mayo Clinic does not accept the BlueCare (51) HMO Plan.
Florida Blue. FloridaBlue.com is your 24 access to your personal health information to videos that show you how to
save money and much more. Find doctors, hospitals, pharmacies in Florida and worldwide.
Participating network providers can be located at www.bcbsfl.com
Out-of-network benefits are available for some plans. However, when an out-of-network provider is used you
will incur an annual deductible and a lower level of benefit coverage. Detailed plan summary documents can be
found on the Human Resources website/Benefits by going to Artemis at www.fscj.edu; log into the faculty and
staff portal; click on “College” at the top of the webpage, then click on Human Resources; or go to
www.fccj.org/campuses/mccs/HumanResources/ .
6
Medical Premiums by Employee Salary
Monthly Active Employee Deductions from January 1 - December 31, 2015
Employee and Dependent Monthly Cost – BlueOptions 03769 Base PPO Plan
Employee Salary
Employee
< $30,000
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
> $70,000
$0
$0
$0
$0
$0
$0
Spouse/Partner
$302
$336
$378
$414
$452
$502
Legal Dependent
Child(ren)
$208
$232
$262
$288
$314
$348
Family
Spouse/Partner & Legal
Dependent Child(ren)
$458
$512
$574
$632
$688
$764
Employee and Dependent Monthly Cost – BlueOptions 03559 PPO Plus Plan
Employee Salary
< $30,000
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
> $70,000
Employee
$59
$59
$59
$59
$59
$59
Spouse/Partner
$350
$384
$426
$462
$500
$550
Legal Dependent
Child(ren)
$244
$268
$296
$322
$348
$384
Family
Spouse/Partner & Legal
Dependent Child(ren)
$534
$588
$650
$706
$764
$840
Employee and Dependent Monthly Cost – BlueCare 51 HMO Plan
Employee Salary
< $30,000
$30,000 - $39,999
$40,000 - $49,999
$50,000 - $59,999
$60,000 - $69,999
> $70,000
Employee
$36
$36
$36
$36
$36
$36
Spouse/Partner
$312
$348
$388
$426
$464
$514
7
Legal Dependent
Child(ren)
$216
$240
$268
$296
$322
$356
Family
Spouse/Partner & Legal
Dependent Child(ren)
$478
$532
$594
$652
$710
$786
HEALTH PLAN
Discounted Programs & Services
Effective January 1, 2015
Additional Benefits and Features

Access to valuable health information and resources, including care decision support, an online
provider directory to find doctors, hospitals, pharmacies in Florida and worldwide at www.bcbsfl.com
and additional interactive web-based support tools.

Expert advice on call. We encourage you to call BCBSFL care consultants team at 1-888-476-2227
to find out how much they can help you SAVE. Whether comparing the cost of your medications
between local pharmacies or researching the quality and cost of treatment options before you make a
decision, care consultants can help you shop for the best value for you and your family.

Online access to participating physician offices for e-office visits, consultations, appointment
scheduling or cancellation, prescription refills and much more.

Members will receive a Member Health Statement that summarizes their health care activity for the
preceding month.
Physician Discount
Many NetworkBlue physicians offer BlueOptions members a rate which is at least 25 percent below the usual
fees charged for services that are not Covered Services under your health plan. By taking advantage of this
discount, you get the care you need from the doctor you trust. However, Florida Blue does not guarantee that
a physician will honor the discount. Since you pay out-of-pocket for any non-covered services, it is your
responsibility to discuss the costs and discounted rates for non-covered services with your physician before you
receive services. ‘Physician Discount’ is not part of your insurance coverage or a discount medical plan. For
more information, please refer to the online Provider Directory at www.bcbsfl.com.
FloridaBlue.com
FloridaBlue.com is your online gateway to everything about your health benefit plan as well as all self-service
tools, now including an enhanced WebMD website especially for our members only.
A 24/7 online member self-service tool with interactive web-based options. Through the FloridaBlue.com
website at www.bcbsfl.com employees can:
View/Request Benefit Booklet
Visit Living Healthy with WebMD
Compare Drug Prices
Pharmacy Claims & Drug Information
View/Print Forms
Find a Doctor/Facility
View Claim Activity
View Current Benefits
View Health Statements
Print/Request Health Insurance Card
Visit the Health Resource Center
8
HEALTH PLAN
Uninsured Children Coverage Option
Effective January 1, 2015
Florida KidCare
Through Florida KidCare, the state of Florida offers health insurance for children from birth through age
18, even if one or both parents are working. It includes four different parts. When you apply for the
insurance, Florida KidCare will check which part your child may qualify for based on age and family
income. For additional information or to receive an application, visit their Web site at
www.healthykids.org or call their toll free number 1-888-540-5437.
Some of the services Florida KidCare covers are:









Doctor visits
Check-ups and shots
Hospital
Surgery
Emergencies
Vision and Hearing
Dental
Mental Health
Prescriptions
Eligibility
Florida KidCare is for children, not adults. To qualify for premium assistance, a child must:




 Not be eligible for Medicaid
 Not be the dependent of a state employee
eligible for health insurance
 Not be in a public institution
Be under age 19
Be uninsured
Meet income eligibility requirements
Be a U.S. citizen or qualified non-citizen
9
DeltaCare (DHMO)
Effective January 1, 2015
Eligibility
Employee, spouse, domestic partner and legal
dependent children up to age 26 if the
dependent (1) depends on the employee for
support (2) is living in your household or a fulltime or part-time student and otherwise not
eligible for employer group coverage.
Deductibles
No deductibles
Maximums
No annual or lifetime dollar maximums
Office Visit Fee
$5.00
Basic
Benefits
0
Months
Waiting Period(s)
Benefits and
Covered Services
Major Benefits
0 Months
Delta Dental DHMO
Preventive Services
Oral Exam
Complete x-rays
Prophylaxis (1 per 6 month period)
Fluoride (1 per 6 month period)
Sealant – per tooth (permanent molars
through age 15)
Restorative Services
Amalgam
Resin (one surface)
Endodontics
Root Canal Therapy (anterior)
Root Canal Therapy (molar)
$110.00
$245.00
Oral Surgery
Extraction, erupted tooth
$18.00
No cost
No cost
$28.00
Major Services
Crown (porcelain/ceramic)
$485.00
Orthodontics
Evaluation
Records/Treatment Planning
Orthodontic Treatment (up to 19 yrs.)
Orthodontic Treatment (adult)
Delta Dental Insurance Company
1130 Sanctuary Parkway, Suite 600
Alpharetta, GA 30009
Orthodontics
0 Months
$25.00
$100.00
$2,100.00
$2,250.00
Customer Service
800-422-4234
Claims Address
P.O. Box 1809
Alpharetta, GA 30023-1809
This benefit information is not intended or designed to replace or serve as the plan’s Evidence of
Coverage or Summary Plan Description. If you have specific questions regarding the benefits, limitations
or exclusions for your plan, please contact a Benefit’s Specialist.
PREMIUMS: JANUARY 1, 2015– DECEMBER 31, 2015
Employee Coverage (Employer paid)
Family (Spouse/Domestic Partner and/or Legal Dependent Child/ren)
10
$13.71
$15.86
Preferred Provider Organization (PPO)
Effective January 1, 2015
Eligibility
Employee, spouse/ domestic partner and legal dependent children up
to age 26 if the dependent (1) depends on the employee for support
(2) is living in your household or a full-time or part-time student and
otherwise not eligible for employer group coverage.
Deductibles
$50 per person / $100 per family each calendar year
Deductibles waived for
Diagnostic & Preventive
Maximums
Yes
D & P counts toward maximum?
Waiting Period(s)
Benefits and
Covered Services*
Diagnostic & Preventive Services
( Diagnostic & Preventive ) Exams,
cleanings, x-rays
Basic Services
Fillings, simple tooth extractions
Endodontics (root canals)
Covered Under Basic Services
Periodontics (gum treatment) Covered
Under Basic Services
Oral Surgery
Covered Under Basic Services
Major Services
Crowns, inlays, onlays and cast
restorations, bridges and dentures
Orthodontic Benefits
Legal dependent children age 19 or
to age 26 if they meet eligibility rules
Orthodontic Maximums
Lifetime
Delta Dental Insurance Company
1130 Sanctuary Parkway, Suite 600
Alpharetta, GA 30009
$1,500 per person each calendar year
No
Basic Benefits
0 Months
Delta Dental PPO
dentists**
Major Benefits
0 Months
Orthodontics
0 Months
Non-Delta Dental PPO dentists**
100 %
100 %
80 %
80 %
80 %
80 %
80 %
80 %
80 %
80 %
50 %
50 %
100 %
100 %
$ 1,500 Lifetime
$ 1,500 Lifetime
Customer Service
800-521-2651
Claims Address
P.O. Box 1809
Alpharetta, GA 30023-1809
* Limitations or waiting periods may apply for some benefits; some services may be excluded from your plan.
Reimbursement is based on Delta Dental maximum contract allowances and not necessarily each dentist’s
submitted fees.
** Reimbursement is based on PPO contracted fees for PPO dentists, Premier contracted fees for Premier dentists
and PPO contracted fees for non-Delta Dental dentists.
This benefit information is not intended or designed to replace or serve as the plan’s Evidence of Coverage or
Summary Plan Description. If you have specific questions regarding the benefits, limitations or exclusions for
your plan, please contact a Benefit’s Specialist.
PREMIUMS: JANUARY 1, 2015– DECEMBER 31, 2015
Employee Coverage (Employer paid)
Spouse/Domestic Partner
Legal Dependent Children
Family (Spouse/ Domestic Partner and/or Legal Dependent Children)
11
$32.25
$31.03
$35.60
$48.10
VisionCare Plan (VCP)
Effective January 1, 2015
LASIK – Vision correction is available through the Refractive Care Program to employees and covered dependents at
substantially reduced fees. To take advantage of this significant plan enhancement, contact VisionCare to request a
LASIK ID card and a list of network eye doctors for an initial screening.
HOW MUCH YOU PAY
When you select a doctor from the VisionCare Plan list, this plan covers the visual care described (examination,
professional services, lenses and frames) at no expense to you except a deductible of $10.00 for the vision
examination and separate deductible for any prescribed materials. Any additional care, service and/or materials
not covered by this plan may be arranged between you and the doctor.
Service
 Vision exam
 Prescribed materials
 Non-essential contact lenses
 2nd pair of eyeglasses
Service Frequency
 Vision exam:
 Lenses:
 Frame:
Co-payment
$10.00 deductible
$15.00 deductible
$120.00 flat allowance
20% discount
Once every 12 months
Once every 12 months
Once every 24 months
S AV I N G S ! S EE T H E D I FFE R EN C E
You can save money two ways with VisionCare. First, the cost of plan services and materials is discounted
a n d prepaid. So except for any co-payments, you have no out-of-pocket expenses for covered services
and supplies when you use one of our network doctors. Second, your coverage costs are deducted
from your pay before any federal income or FICA taxes are taken out. This makes your taxable wage base
lower, so you would pay less tax.
Refer to your Humana VisionCare Plan certificate for more important information about this employee
benefit or call Customer Service at 1-800-865-3676. Certificates can be obtained at
www.humanavisioncare.com
PREMIUMS: JANUARY 1, 2015 – DECEMBER 31, 2015
Employee Coverage (Employer Paid)
$4.40
Family (Spouse/ Domestic Partner and/or Legal Dependent Children)
$5.25
12
Florida College System Risk Management Consortium
Dental and Vision Plan (DV)
Employees Who Opt-Out of Health Insurance Plans
Effective January 1, 2015
DV Plan
www.DeltaDental.com
www.VSP.com
Network
PPO Network/Premier
Network
Well Vision Exam
Deductible
$50 per person, not to exceed
$150 per family, per calendar yearapplies to Basic and Major
Services
Maximum Benefits
Preventive Services
Basic Services
Major Services
Missing Tooth Rule
Orthodontics
Prescription Glasses
$1,000 Calendar Year Maximum
No Deductible - provided at 100%
of PPO provider fee schedule for
Oral Examinations, Cleanings (two
per calendar year) and Bitewings
X-rays
Full Mouth X-rays, Periodontics
(Gum Treatment), Endodontic
(Root Canals), Oral Surgery and
Restorative Services (Fillings) are
covered at 80% of the PPO
provider fee schedule in-network
and 50% non-PPO network
Crowns, Bridges, Full Dentures,
Partial Dentures and Implants are
covered at 50% of the PPO
provider fee schedule in-network
and 50% out-of-network
Teeth extracted prior to effective
date are covered
Child only, $1,000 max.
The out-of-network benefits are increased for those seeking
services from a Premier provider and Preventative Services
are covered at 100%
Frames
Contacts (instead of
glasses)
Laser Vision
Correction
Rates
Employee (Employer
Paid)
Spouse (Employee
Paid)
Choice Network
$10 Co-payment every 12
months
$10 Co-payment for lenses
single vision, lined bifocal,
and lined trifocal lenses
every 12 months
$150 allowance for a wide
selection of frames or 20%
off the amount over your
allowance
Every 12 months - up to
$60 Co-payment for your
contact lens exam (fitting
and evaluation) and $120
allowance for contact lens
material
Average 15% off the regular
price or 5% off the
promotional price.
Discounts only available
from contracted facilities.
Two Year Rate Guarantee
thru 12/2016
Child(ren) (Employee
Paid)
Family (Employee Paid)
Spouse/ Domestic
Partner and/or Legal
Dependent Children
The DV Plan was designed as an alternative plan for employees with other adequate
health insurance and is an employer paid benefit for employees only. Benefits may be
extended to the participant’s eligible dependents.
13
$111.00
$33.14
$33.95
$73.75
TAX ADVANTAGED PLAN
Flexible Spending Accounts (FSA)
Effective January 1, 2015
An FSA is a pre-tax benefit under the IRS Code that allows employees to reduce their taxable income to pay
for out-of-pocket medical, dental, vision and dependent care expenses without paying federal, state or FICA
taxes, saving up to 30% in taxes on those dollars. Employees elect an annual amount to be set aside for their
out-of- pocket health and dependent care expenses. Amounts are withheld in equal increments through
payroll deductions. Any remaining funds left in your FSA medical account up to $500, as of December
31st will rollover to the next year.
SPECIAL NOTE:
If the employee verifies credible medical insurance coverage from a non-College source, the College may
approve the voluntary withdrawal of the employee from the College’s medical insurance plans. In such cases,
the College will deposit $720* to a Health Flexible Spending Account in the employee’s name. The employee
may also contribute an additional amount up to the maximum amount of $2,500. *If the medical insurance
coverage from a non-College source is an HSA Plan, the employee would not be eligible for the FSA Medical
Flexible Spending Account and/or the $720.*
*Employees hired after January 1, 2015 will have a prorated contribution based on date of hire.
If you wish to contribute funds into the FSA, an enrollment form must be completed during the open
enrollment period annually. You will not be allowed to cancel or change your election during the 12-month
agreement period unless you have a qualifying life event.
Flexible Spending Account Advantages:
There are several reasons to take advantage of an FSA offered by the College. In addition to the tax savings,
many employees also find an FSA is an easy and effective way to budget for medical expenses throughout
the year, especially if you have maintenance medications or supplies you use on a regular basis.
Another reason to take advantage of an FSA is it could actually increase your amount of take-home pay. This
is because the money added to the FSA is not subject to payroll taxes, which could then lower your tax
bracket and lower your annual income tax payments. If your taxable income is lowered, your take-home pay
can go up!
Medical Spending Account (Funds available upfront):
 Annual contribution limit of $2,500
 Debit cards can be used to pay your group co-pays or out-of-pocket expenses where MasterCard is
accepted
 Expenses include: eligible medical, vision and dental expenses
Dependent Care Account (Funds available as deducted each pay period):
 Annual contribution limit of $5,000
 Pay for dependent day care expenses (for your legal dependent child(ren)) up to age 13 and any
other dependent claimed on your federal income tax return
 A dependent care account may only be used when both you and your spouse (if applicable) are
gainfully employed
Maximum Contribution: $5,000.00 if your filing status is Single or Married Filing a Joint Return.
$2,500.00 if your filing status is Married Filing Separate
Paper claims are not necessary following the electronic transaction; however, employees need to maintain
all receipts to substantiate your claim. The IRS requires MEDCOM to audit and/or verify certain transactions,
which will be done through a written request of you (the employee). You will only have to file a paper claim if
a provider does not accept MasterCard or if you do not have your card at the time of purchase.
www.medcom.net.
14
TAX ADVANTAGED PLANS
Effective January 1, 2015
Voluntary 403(b) Plan
The College offers employees the opportunity to participate in a tax-deferred retirement savings plan,
provided by Section 403(b) of the Internal Revenue Service (IRS) Code.
The salary reduction contributions may only be made to the 403(b) vendors who meet the new IRS
requirements and are authorized by the College. The five authorized vendors are:



Fidelity Investments
Voya (ING) Retirement Plans


Metropolitan Life Insurance
Company (MetLife)
TIAA-CREF
Valic
Eligible employees who wish to establish a voluntary 403(b) account should select and contact an
authorized provider. Once an account has been established, employees sign a Salary Reduction
Agreement and forward the agreement to the Payroll Department. Changes in the amount of the Salary
Reduction Agreement may be processed by submitting a new agreement indicating the changes desired.
TSA Consulting Group, Inc. (TSACG) serves as the plan administrator of the College’s 403(b) and
457(b) plans. All transactions for active accounts must be reviewed by TSACG using a transaction routing
request found at www.tsacg.com.
Basic Annual Limit: $18,000
Service-Based “Catch-up”: $21,000 (an additional $3,000 per year; must have 15 or more years with
Florida State College at Jacksonville as well as an average contribution per year of less than $5,000.00).
Age-Based Additional Amount: 50 or older by December 31: $18,000 + additional $6,000 = $24,000.
Voluntary 457(b) Deferred Compensation Plan
This is a non-qualified deferred compensation plan that works much like the 403(b) accounts. All employees
may elect to participate in the plan with an annual maximum amount of $18,000. The 457(b) contributions do
not reduce the FICA taxes (Social Security & Medicare).
Eligible employees who wish to establish a voluntary 457(b) account should select and contact an
authorized provider. Once an account has been established, employees sign a Salary Reduction
Agreement and forward the agreement to the Payroll Department. Changes in the amount of the Salary
Reduction Agreement may be processed by submitting a new agreement indicating the changes desired.
Basic Annual Limit: $18,000
“Catch-up” Provisions: Unlike 403(b) accounts, “catch-up” provisions are only allowed during the final three
(3) full calendar years of service prior to the year of retirement. Age-Based Additional Amount: 50 or older
by December 31: $18,000+ additional $6,000 = $24,000.
The salary reduction contributions may only be made to the 457(b) vendors who meet the new IRS
requirements and are authorized by the College. The three authorized vendors are:



Fidelity Investments
TIAA-CREF
Valic
15
403(b) vs. 457(b): Which is better?
Both 403(b) and 457(b) retirement plans are deferred compensation plans. Under both plans, the employee
contributes pretax income, and pays no taxes on monies held in the plan until separating from the employer
and making withdrawals. Both plans offer a selection on investment opportunities through the plan sponsor.
Talk to your financial advisor about which plan is a better fit for your particular situation.
“How do the plans differ?”
403(b)
457(b)
403(b)
It’s easier to access the funds
while you are with the employer
Less stringent withdrawal
restrictions while you are
employed, but a 10% federal early
withdrawal penalty might apply.
457(b)
You’re not subject to the 10%
federal early withdrawal penalty
once you leave the employer
More stringent withdrawal
restrictions while you are
employed, but no 10% federal
early withdrawal penalty after
severance from employment
[except in the case of rollovers
from non-457(b) plans, including
IRA’s].
Generally withdrawals made prior
to severance from employment or
the year you attain age 59½ can
only be made due to financial
hardship.
Generally withdrawals made prior
to severance from employment or
the year in which you reach age
70½ can only be made for an
unforeseeable emergency.
A financial hardship withdrawal is
considered less restrictive – while
you are employed – than a 457(b)
unforeseeable emergency.
Examples of financial hardship
include:
An unforeseeable emergency is
more restrictive – while you are
employed – than a 403(b)
hardship. Some examples:




Unreimbursed medical
expenses
Payments to purchase a
principal residence
Higher education
expenses
Payments to prevent
eviction or foreclosure of
a mortgage.
Withdrawals can be subject to a
10% federal early withdrawal
penalty prior to age 59½.
16



A sudden and
unexpected illness or
accident for you or a
dependent
Loss of your property due
to casualty
Other similar
extraordinary
circumstances arising as
result of events beyond
your control.
Sending a child to college or
purchasing a home, two common
reasons for 403(b) hardship
withdrawals, generally are not
considered unforeseeable
emergencies.
The 10% federal early withdrawal
penalty, generally applicable to
distributions prior to age 59½ from
a 403(b) plan, does not apply to
distributions from 457(b) plans
except on amounts rolled into the
plan from nono-457(b) plans
(including IRAs).
TAX ADVANTAGED PLANS cont’d
Effective January 1, 2015
Mandatory 403(b) Terminal Leave Plan
The FSCJ 403(b) Retirement Plan is provided as a means of maximizing tax advantages on terminal pay
to College employees by deferring Federal withholding taxes and permanently avoiding Social Security
and Medicare taxes on eligible accumulated sick and annual leave payments. The maximum Plan
contribution limit is calculated each year. All Plan contributions are 100% vested when deposited.
The 403(b) Terminal Leave Plan is:
1) Mandatory for employees who separate from the College and are due at least $7,000 in terminal
“payout” for their unused sick and annual leave from Florida State College at Jacksonville; and
2) Mandatory for employees upon entry into the Deferred Retirement Option Program (DROP).
For College employees who are not eligible for the Florida Retirement System Deferred Retirement
Option Program (DROP) and who wish to gain additional federal income tax benefits for monies over the
IRS annual limit, they may submit an irrevocable letter of separation to the District Board. The irrevocable
letter of separation must be accepted by the Board in the Plan Year preceding the employee’s separation
from the College.
17
RETIREMENT PLANS
Effective January 1, 2015
Florida Retirement System (FRS)
Full-time and regular part-time employees are automatically enrolled in the Florida Retirement System on their first day of
employment. FRS has two retirement plans from which employees may choose the Pension and the Investment. The
choice to participate must be made within five (5) months after the month of hire or it defaults to the Pension Plan.
Employees must contribute 3% of their salary, on a pre-tax basis, to FRS. This will automatically be deducted each pay
period. Employee contributions in the Investment Plan will accumulate earnings, minus investment fees and administrative
charges. Employee contributions in the Pension Plan will not earn interest. Your salary will be reduced by the amount of
the employee contribution before determining the federal income tax deduction. Members must be separated for 3
calendar months to be eligible to receive a refund of their employee contribution (it would be the employee’s responsibility
to contact FRS). Employees are given a one time, irrevocable choice to switch plans. These plans include:
FRS Pension Plan – the traditional plan provides a formula-based income at retirement. This defined benefit plan also
provides a disability and a death benefit. The vesting period is six (6) years of creditable service for members hired
before July 1, 2011. The vesting period is 8 years of creditable service for members hired on or after July 1, 2011.
Deferred Retirement Option Program (DROP) – this option, within the FRS Pension Plan, allows employees to retire
and have their retirement benefits accumulate in the FRS Trust Fund, earning tax-deferred interest, while they continue to
work for an FRS employer and receive their regular pay and benefits. To be eligible, an employee must meet the FRS
Retirement definition*.

If you are a DROP participant or a reemployed retiree who is not allowed to renew membership, you will
not be required to make the 3% employee contribution.

If you have an effective DROP begin date before July 2011, you will retain an annual interest rate of 6.5%.

If you have an effective DROP begin date on or after July 1, 2011, you will have an annual interest rate of
1.3%.
*Retirement Definition: If hired before July 1, 2011, requires 6 years of creditable service and age 62 or 30 years of
service regardless of age. If hired on or after July 1, 2011, requires 8 years of creditable service and age 65 or 33 years of
service regardless of age.
FRS Investment Plan: – the plan allows employees to control how their retirement contributions are invested. The law
defines the employer contributions, but your ultimate benefit depends in part on the performance of your investment
funds. Employees will have five (5) months after the month of hire to elect an FRS Plan; if no election is made the choice
defaults to the Pension Plan. Vesting period is one (1) year.
FRS Senior Management – As defined by state law, employees must contribute 3% of their salary, on a pre-tax basis, to
FRS. This will automatically be deducted each pay period. Members must be separated for 3 calendar months to be
eligible to receive a refund of their employee contribution (it would be the employee’s responsibility to contact FRS).
Employees are given a one time, irrevocable choice to switch plans.
Community College Optional Retirement Program – CCORP:
*Option eliminated for employees hired after August 31, 2011*
Full-time faculty, administrator, and professional employees had the option to elect to participate in a 403(b) tax-sheltered
annuity plan in lieu of the Florida Retirement System. Under this plan, the College contributes a percentage as defined by
law, of a participating employee's gross salary to any one of five plans elected by the employee. Employees in the
CCORP plan must contribute 3% of their salary, on a pre-tax basis.
CCORP participants have a one-time opportunity to switch to a FRS Plan. These options may be exercised at a future
time during your career under the CCORP. You may also choose to simply remain in the CCORP and take no further
action. To review these options, please call the MyFRS Financial Guidance Line at 1-866-446-9377 or visit the Web site
www.MyFRS.com.
18
The Hartford LIFE INSURANCE COVERAGE
Effective January 1, 2015
The Hartford Insurance Company
The term life insurance plan with Hartford Life Insurance Company provides a death benefit equal to your
annual salary (basic coverage) rounded to the nearest $1,000. The College pays for the basic coverage.
During the first 30 days of employment, employees have the option to buy, without evidence of insurability,
guaranteed supplemental coverage of one, two, or three times this amount up to $350,000, which includes
the College paid portion. After the first 30 days of employment, evidence of insurability may be required to
purchase supplemental term life insurance. The employee is responsible for paying for supplemental term life
insurance through payroll deductions at the cost of $.205 per $1,000 per month.
Conversion is available with no proof of insurability if your employment ends.
Please note, as of December 31, 2003, retirees and active employees who enrolled in the Deferred
Retirement Option Plan (DROP) with irrevocable retirement dates are considered as Retiree-Closed Class.
New employees retiring or starting DROP after January 1, 2004, will be considered as Retiree-Open Class
and will not receive premium subsidization from the College.
Full-Time Employees and Retirees may carry basic term life insurance coverage (annual salary rounded to
nearest $1,000 at time of retirement) until age 70 at which time coverage is reduced to 50% of basic
coverage. The retiree is responsible for payment of life insurance premiums:
Retiree-Closed Class Premium - $ 1.07 per $1,000.00
Retiree-Open Class Premium $ 1.96 per $1,000.00
Full-time employees have the opportunity to purchase from Hartford Life Insurance Company supplemental
life insurance for their spouse, domestic partner and eligible legal dependent children. To be eligible you
must currently be paying for supplemental life insurance with the College. This benefit will allow you to insure
your spouse/domestic partner for $25,000 at a cost of $7.64 per month with a two-year rate guarantee. The
legal dependent child(ren) life insurance policy insures all eligible dependent children in a family unit with one
monthly premium regardless of the number of children in the family. This is a $10,000 benefit per child at the
monthly rate of $2.10 with a two-year rate guarantee. An employee must submit and pass an evidence of
insurability review for spouse or domestic partner’s coverage.
Employee and Retiree General Provisions: Upon the first day of the month following an insured employee
70th birthday, an insured employee’s amount of basic and supplemental, and retiree’s term life insurance shall
be reduced to 50% of the amount in effect immediately prior to attaining age 70.
Dependents General Provisions: Upon the first day of the month following an insured spouse’s 70th
birthday, his or her amount of term life insurance shall be reduced to 50% of the amount in effect immediately
prior to attaining age 70.
Legal dependent children are eligible if they have not attained the age of 19, or have not attained the age of
25 if a full-time or part-time student in an accredited educational institution.
Will Preparation Services – The Hartford Life Insurance Company provides assistance with the creation of
wills, power of attorney, financial arrangements, etc. Visit their website at wwwestateguidance.com/wills;
use code WILLHLF. You’ll have access to Guidance Resources by calling 1-800/964-3577.
Travel Assistance – When traveling 100 miles or more away from home, The Hartford Life Insurance
Company is partnered with Europ Assistance USA to provide 24-hour access to emergency assistance and
resources. Contact 1-800-243-6108 (U.S. and Canada) or call collect at 1-202—828-5885 (other locations
outside of the U. S. and Canada) or visit their website at www.europassistance-usa.com.
19
Long Term Disability (LTD)
Effective January 1, 2015
The Hartford Company - Long Term Disability
All full-time employees are eligible for long term disability insurance coverage. The College provides this
coverage at no cost to full-time active employees.
There is a 180-day elimination period. If approved, an employee would resign with the College and receive up
to 60% of their monthly salary from Hartford.
To apply, contact a Benefits Specialist to assist you with the process.
HealthAdvocate Employee Assistance Program (EAP)
EAP + Work/Life
HealthAvocate Employee Assistance Program
The Employee Assistance Program (EAP) through Health Advocate is a short-term, confidential counseling
and/or crisis intervention service provided for employees. They offer professional support for personal and
work/life issues. This program provides college employees with real support when you need it:



Up to eight free sessions per year for you and your family.
There is no cost to use the service
24-Hour CARELINE 877-240-6863
How can you find out more?
Get short-term assistance to help you cope with personal, family and work issues, and the right resources to
better balance your work and life. The Health Advocate staff follows careful protocols and complies with all
government privacy standards. Your medical and personal information is strictly confidential. Your privacy is
protected.
Visit www.HealthAdvocate.com/members to find useful information on a wide range of topics or send an
email to answers@HealthAdvocate.com
20
ADDITIONAL BENEFITS
Annual Leave - Full-Time Employees
Career employees earn vacation time as follows.
First five years
12 days per year
Six to 10 years
15 days per year
10 years and over
18 days per year
Career employees may carry over annual leave into the next calendar year with a cap of 44 days
(352 hours).
Administrative and Professional employees earn vacation time as follows:
First five years
Six to 10 years
10 years and over
16 days per year
19 days per year
22 days per year
Administrative and Professional employees may carry over annual leave into the next calendar year
with a cap of 44 days (352 hours).
Senior Management employees earn vacation time as follows:
First five years
Six to 10 years
10 years and over
20 days per year
22 days per year
24 days per year
Senior Management employees may carry over annual leave into the next calendar year with a cap of
60 days (480 hours).
Accrued vacation leave in excess of the maximum on December 31 shall be transferred to sick leave
on January 1 of the following year. Such vacation leave transferred to sick leave will be classified as
non-compensatory accrued sick leave and cannot be used in the calculation of terminal sick leave
pay.
Sick Leave
All full-time employees earn eight hours of sick leave per month. Employees also have the option to
use 32 hours per calendar year as personal leave. Employees may carry over unused sick leave into
the next calendar year.
Sick Leave Pool
Full-time employees are eligible to enroll in the sick leave pool after they have been employed for one
year and have a sick leave balance of at least 72 hours. The open enrollment period occurs during
the College’s annual open enrollment; with a membership effective date of January 1. To enroll, an
employee voluntarily contributes 16 hours of sick leave to the pool.
If the employee has a catastrophic emergency/life threatening illness or injury and has depleted
all of his or her own sick leave, they may apply for additional hours from the pool. The decision to
grant hours is made by the Sick Leave Pool Committee. The application form to include the
physician’s report may be obtained from a Benefits Specialist in Human Resources.
21
ADDITIONAL BENEFITS cont’d
Worker’s Compensation
All employees are covered by Workers’ Compensation. Workers’ Compensation provides partial wage
continuation and pays the cost of medical treatment health care cost (if applicable) if an employee has been
injured while on the job.
Family Medical Leave Act (FMLA)
The Family and Medical Leave Act (FMLA) of 1993 provides an entitlement of up to 12 weeks (480 hours)
of job-protected, unpaid leave during a 12-month period to employees who have worked for the College for at
least one year and have worked at least 1,250 hours during the previous 12-month period. Eligible
employees may take FMLA leave for the following reasons:
1.
Because of the birth of a son or daughter of the employee and in order to care for such son or daughter.
2.
Because of the placement of a son or daughter with the employee for adoption or foster care.
3.
In order to care for the spouse, son, daughter or parent of the employee who has a serious health condition.
(Parent cannot be an “in-law”.)
4.
Because of a serious health condition that makes the employee unable to perform the functions of his/her
position.
5.
To care for a covered service member (spouse, child, parent, next of kin) that has a serious health condition (up
to 26 weeks of job-protected leave). For the purposes of this procedure, next of kin of a covered service member
is the nearest blood relative, other than the current service member’s spouse, parent, son, or daughter in the
order of priority as established under the U.S. Department of Labor guidelines. Support documentation
paperwork for military FMLA shall be presented as soon as practicable.
6. For a “qualifying exigency” arising out of the fact that the spouse, child or parent is on active duty or called to
active duty status in support of a contingency operation of the National Guard or Reserves .
For additional information or for the forms to apply for FMLA, go to Artemis at www.fscj.edu; log into the
faculty and staff portal; click on “College” at the top of the webpage, then click on Human Resources; or go to
www.fccj.org/campuses/mccs/HumanResources/.
Long Term Care (LTC) Insurance
Employees have the option of purchasing Long Term Care (LTC) insurance through Unum. LTC is the
assistance received when someone needs help with two or more Activities of Daily Living—such as dressing,
bathing, going to the bathroom, eating or moving about—or when someone suffers a severe cognitive
impairment. This care could be provided in the home, in an assisted living or residential care facility, or in a
skilled nursing facility such as a nursing home. For additional information, please contact a Benefits
Specialist. Newly hired employees will have 30 days, from date of hire, to sign up for Guarantee Issue
coverage. Employees who enroll after the Guarantee Issue enrollment period will be required to fill out a
medical questionnaire.
Tuition Reimbursement
The College will waive or reimburse tuition and matriculation fees for courses taken at the College for full-time
employees and their dependents and regular part-time employees (refer to APM 03-0910). Undergraduate
and graduate courses taken at accredited institutions other than the College are reimbursable up to $3,000
per fiscal year for undergraduate courses and up to $4,000 per fiscal year for graduate courses. (APM 121501).
22
ADDITIONAL BENEFITS cont’d
COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) gives qualified beneficiaries (defined as
employee, spouse and/or dependents) who lose their health benefits the option to elect to continue their
health insurance, dental insurance, vision insurance and flexible spending account(s) for limited periods of
time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked,
transition between employers, death, divorce, and other life events. COBRA coverage begins on the date
health care coverage would otherwise have been lost by reason of a qualifying event and may continue for a
maximum of 18 months. Certain qualifying events, such as divorce or legal separation of an employee, or a
second qualifying event during the initial period of coverage, may permit a beneficiary to receive a maximum
of 36 months of coverage.
Qualified beneficiaries that elect Cobra will be required to pay the entire premium plus a two percent
administration fee each month to maintain coverage.
Holidays
The College President shall designate one (1) paid holiday in the annual operating calendar to total
Ten (10) official paid holidays annually.
New Year’s Day
Martin Luther King, Jr. Day
President’s Day
Designated Holiday (May 6)
Memorial Day
Independence Day
Labor Day
Veteran’s Day
Thanksgiving Day and Break
You must be in an active pay status the day before and the day after an official College holiday to receive pay
for that holiday. Employees who begin or terminate work during a pay period when the College is officially
closed will be paid for the days worked should their employment not encompass the entire pay period.
Administrator, professional and career employees work 250 days. Spring and winter breaks are not part of the
250 days’ work calendar.
Benefits Election Changes
 Open Enrollment
Employees may change their health, dental, or vision plans and enroll in the Flexible Spending
Account, 403(b) plan, or Long Term Care plan during the designated open enrollment period.
 Qualifying Events
Employees may make changes to their health, dental and vision plans (i.e., add/drop dependents) as
well as modify their Flexible Spending Account deductions within 30 days of a qualifying event.
Such events include marriage, divorce, birth, adoption, death, gain and loss of other coverage.
For changes made due to ANY qualifying event, supporting documentation is required. Please
contact a Benefits Specialist for assistance.
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CONTACT INFORMATION
Human Resources - Benefits Contact Email:
Benefits@fscj.edu
Health Insurance (Florida Blue) Group No: 16087
www.bcbsfl.com
Claims Address:
Florida Blue
P. O. Box 1798
Jacksonville, FL 32231-1798
BlueCare 51 (HMO)
www.bcbsfl.com
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BlueOptions 03769 (PPO Base) Plan and BlueOptions 03559 (PPO Plus) Plan
www.bcbsfl.com
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Mental Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Health Dialog . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
www.thedialogcenter.com/bcbsfl
BlueCard Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1-877-352-2583
1-800-664-5295
1-800-835-2094
1-877-789-2583
1-800-810-2583
Delta Dental Plan
www.deltadentalins.com
Delta Care Dental (HMO) Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Group No: 76894
1-800-422-4234
Delta Dental (PPO) Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Group No: 16724
1-800-521-2651
Humana (VisionCare Plan)
www.humanavisioncare.com
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Group No: 207135
1-800-865-3676
Florida College System Risk Management Consortium D/V Plan
Delta Care Dental (PPO)
Group No: 16020
www.deltadentalins.com
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1-800-521-2651
Vision Service Plan (VSP)
www.vsp.com
Group No: 30035956
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1-800-877-7195
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The Hartford Life Insurance Company
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Will Preparation Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Travel Assistance (U.S. and Canada) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Travel Assistance (Other Location outside U.S. and Canada) . . . . . . . . . . . . . . . . . . . . . . . . .
1-888-563-1124
1-800-964-3577
1-800-243-6108
1-202-828-5885
Medcom (FSA)
www.medcom.net
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
904-596-4500
Claims Address:
MEDCOM
Flex Division
P. O. Box 10269
Jacksonville, Florida 32247-0269
Employee Assistance Program (EAP) Health Advocate
www.HealthAdvocate.com/members
Email: answers@healthadvocate.com
24 Hours/7 Days a Week Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1-877-240-6863
Florida Retirement System (FRS)
www.MyFRS.com
Financial Guidance Line . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Bureau of Retirement Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1-866-446-9377
1-888-738-2252
UNUM (Long Term Care)
www.unum.com
Customer Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1-877-225-2712
25
Florida State College At Jacksonville is an equal access/equal opportunity/affirmative action college.
Florida State College At Jacksonville is a member of the Florida State College
System. Florida State College At Jacksonville is not affiliated with any other public
or private university or college in Florida or elsewhere.
Florida State College At Jacksonville is accredited by the Commission on
Colleges of the Southern Association of Colleges and Schools to award the
baccalaureate degree and the associate degree. Contact the Commission on Colleges at
1866 Southern Lane, Decatur, Georgia 30033-4097, or call (404) 679-4500 for questions
about the accreditation of Florida State College At Jacksonville.
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